2014 APDS SPRING MEETING
Are There Gender Differences in the Emotional Intelligence of Resident Physicians? Sophia K. McKinley, MD,* Emil R. Petrusa, PhD,* Carina Fiedeldey-Van Dijk, PhD,† John T. Mullen, MD,* Douglas S. Smink, MD,‡ Shannon E. Scott-Vernaglia, MD,§ Tara S. Kent, MD,|| W. Stephen Black-Schaffer, MD,¶ and Roy Phitayakorn, MD* Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; †ePsy Consultancy, Toronto, Canada; ‡Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts; § Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; ||Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and ¶Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts *
BACKGROUND: Because academic literature indicates
that emotional intelligence (EI) is tied to work performance, job satisfaction, burnout, and client satisfaction, there is great interest in understanding physician EI. OBJECTIVE: To determine whether gender differences in
resident EI profiles mirror EI gender differences in the general population. STUDY DESIGN (INCLUDE PARTICIPANTS AND SETTING): A total of 325 residents in 3 types of residency
programs (pathology, pediatrics, and general surgery) at 3 large academic institutions were invited electronically to complete the validated Trait Emotional Intelligence Questionnaire (TEIQue), a tool consisting of 153 items that cluster to 15 independent facets, 4 composite factors, and 1 global EI score. RESULTS: The response rate was 42.8% (n ¼ 139, women ¼ 84). Global EI was not significantly different between men and women resident physicians (p ¼ 0.74). Women scored higher than men in the TEIQue facets impulse control (p ¼ 0.004) and relationships (p ¼ 0.004). Men scored higher than women in 2 facets, stress management (p ¼ 0.008) and emotion management (p ¼ 0.023). Within surgery (n ¼ 85, women ¼ 46), women scored higher than men in impulse control (p ¼ 0.006), whereas men scored higher in stress management (p ¼ 0.008). CONCLUSIONS: Men and women residents across 3
specialties demonstrated near-identical global EI scores. However, gender differences in specific TEIQue facets suggest that similar to the general population, men and Correspondence: Inquiries to Sophia Kim McKinley, MD, EdM, MGH Department of Surgery, 55 Fruit St., Boston, MA 02114; e-mail: [email protected]
women residents may benefit from specific training of different EI domains to enhance well-rounded development. The lack of significant gender differences within surgery may indicate that surgery attracts individuals with particular EI profiles regardless of gender. Future research should focus on the functional relationship between educational interventions that promote targeted EI development and enhanced clinical performance. ( J Surg 71:e33-e40. C J 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: emotional intelligence, surgical education,
ACGME core competencies, surgical residency, gender differences COMPETENCIES:
Professionalism, Communication Skills, Patient Care
Interpersonal
and
INTRODUCTION Emotional intelligence (EI) describes how an individual perceives and manages his/her own emotions as well as the emotions of others. Several researchers embrace the conceptualization of EI as an ability, either as a social intelligence or a type of cognitive skill.1-5 Others have promoted a trait conceptualization of EI in which an individual’s EI reflects personal disposition.6,7 Importantly, proponents of both models assert that EI can be taught, learned, and developed.8-10 Perceiving and managing emotions is fundamental to medicine: physicians must navigate their own emotions as well as the emotions of patients and other team members. Intuitively, EI is applicable to the Accreditation Council for Graduate Medical Education (ACGME) core competencies of professionalism and of interpersonal and communication
Journal of Surgical Education & 2014 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsurg.2014.05.003
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skills. As such, there has been an increasing call for incorporating the development of EI into medical training.11-16 Using a variety of EI tools, different investigators have examined EI at the undergraduate and graduate medical education levels to determine whether EI has the power to predict clinical or academic performance with mixed results.17-24 What underlies these investigations is the idea that if overall EI or its subsets are tied to performance, then targeted development of those EI domains will result in enhanced outcomes. The business literature in particular has demonstrated that career success is predicted by EI and calls for EI development as a method of improving an individual’s work performance.25-27 Before designing any interventions that develop and optimize physician EI, it is important to understand if any baseline factors affect EI scores. A large general population study found a large number of gender differences in EI domains, which suggests that to achieve well-rounded development, men and women may require training in different areas.8 The present study was conducted to determine whether gender differences in resident physicians mirrored those found in the general population to ensure that future selection of EI targets inclusively benefits as many trainees as possible and does not primarily address the needs of one gender over the other. In particular, we predicted that female resident physicians would demonstrate higher global scores than male residents on an EI assessment given studies of medical students that have demonstrated this pattern.28-32
METHODS Participants and Recruitment Resident physicians in the pathology, pediatrics, medicinepediatrics (med-ped), and surgery residency programs at a large academic medical center were eligible to participate. Surgery residents at 2 other large academic centers in the same city were also invited to participate in the study. This was a convenience sample based on the agreement of the program directors of these residency programs to allow their residents to participate. Residents were invited electronically to participate in the study with up to 3 reminder invitations sent only to nonresponders. Participation in the study was voluntary. As compensation for their time, residents were offered professional, personalized EI reports valued at approximately $165. To protect participant privacy, a key linking resident identifiers to deidentified survey responses was maintained only by an administrator with no supervisory role over any residents. Study Procedures Potential study participants were invited to the study in August 2013 and allowed up to 8 weeks to complete all study materials from the date of study invitation. Each resident was provided a unique URL to complete an electronic informed consent item and a brief demographics e34
survey, which included participant age, gender, and highest completed clinical postgraduate year. Electronic consent and demographics data were collected using the REDCap electronic data capture tool hosted at Partners Healthcare.33 Research Electronic Data Capture (REDCap) is a secure, web-based application designed to support data capture for research studies. After a resident physician completed the electronic consent and demographics survey, he or she was provided with a personalized link to the main study tool, the Trait Emotional Intelligence Questionnaire (TEIQue). The EI assessment was conducted via a commercial platform (www.thomasus.com) because of its user-friendly interface and the ability to provide study participants with high-quality EI reports. No personally identifiable information was collected on the commercial website. Data collection was closed in October 2013. This study was approved by the Partners institutional review board. Trait Emotional Intelligence Questionnaire This study used the TEIQue version 1.50 (available from www.psychometriclab.com), a psychometrically validated EI questionnaire that takes approximately 15 to 25 minutes to complete. The TEIQue is a 153-item self-assessment tool for EI in which each item is answered on a 7-point Likert scale, depending on how strongly the examinee agrees or disagrees with a particular statement (1 ¼ completely disagree; 7 ¼ completely agree). These 153 items yield scores for 15 EI facets, which then cluster to 4 broader EI factors (Table 1). The 153 items in total also generate a single, global EI score. The TEIQue has been used across a variety of cultures and languages with high reliability: Cronbach α for the overall EI score ¼ 0.92 with typical Cronbach α 4 0.80 and 40.70 for TEIQue factors and facets, respectively.8,34,35 TEIQue global, factor, and facet scores for each of the participating residents were calculated on a 1 to 7 scale by Thomas International per the TEIQue scoring key held by Dr. Petrides’s group at London Psychometric Laboratory, University College London (http://www.psychometriclab.com). Statistical Analyses Subsequent analyses on TEIQue global, factor, and facet raw scores were completed using SPSS version 22 (SPSS Inc, Chicago, IL). A multivariate analysis of variance was conducted on TEIQue facet scores across gender with statistical significance set at p o 0.05. Univariate comparisons between gender groups on TEIQue global, factor, and facet scores were then conducted using the 2-tailed Student t test. For these tests, a statistically significant difference was set at p o 0.025 to reduce the inflation of type I error from multiple hypothesis testing while preserving our interest in detecting gender differences, especially given the large number of gender differences demonstrated in a published general population sample.8 Gender analyses were conducted within
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TABLE 1. TEIQue Facet and Factor Descriptions Factor/Facet Well-being Happiness Optimism Self-esteem Sociability Assertiveness Emotional management Social awareness Emotionality Relationship Empathy Emotion perception Emotion expression Self-control Emotion regulation Impulse control Stress management Independent facets Adaptability Self-motivation
High Scorers Perceive Themselves as the Following Possessing a generalized sense of well-being, feeling positive, happy, and fulfilled. Cheerful and satisfied with their lives. Confident and likely to “look on the bright side” of life. Successful and self-confident. Able to communicate clearly and confidently with people from very diverse backgrounds Forthright, frank, and willing to stand up for their rights. Capable of influencing other people’s feelings. Accomplished networkers with excellent social skills. Skilled in a wide range of emotion-related activities. Capable of having fulfilling personal relationships. Capable of taking someone else’s perspective. Clear about their own and other people’s feelings. Capable of communicating their feelings to others. Having a healthy degree of control over their urges and desires. Capable of controlling their emotions. Reflective and less likely to give in to their urges. Capable of withstanding pressure and regulating stress. Flexible and willing to adapt to new conditions. Driven and unlikely to give up in the face of adversity.
The 153 items of the TEIQue generate scores for 15 distinct emotional intelligence factors, which then cluster to 4 broader emotional intelligence factors. Descriptions of each facet and factor have been adapted from the Trait Emotional Intelligence Questionnaire Technical Manual.8
the group of surgery residents because it was the largest group with a near-equal representation of men and women. Gender analyses were not conducted for pathology or pediatrics/medpeds due to small group sizes and uneven gender distributions. Of note, there were only 8 participating resident physicians who were in dual internal medicine and pediatric residency programs (med-peds) so pediatrics and med-peds residents were combined into a single specialty group.
RESULTS
participants (30.1 ⫾ 3.2) were not significantly different (p ¼ not significant). Overall, 60.4% of respondents were women, though the proportion of men vs women varied, depending on the residency program (Table 2). Multivariate Analysis A 1-way multivariate analysis of variance demonstrated a significant multivariate effect for gender (Hotelling T 2 ¼ 2,2641.58, p o 0.001).
Participants Of the 325 resident physicians who were invited to participate in the study, 139 (42.8%) completed all study materials. Age data were available for 138 (99.3%) participants. The mean age of male participants (30.2 ⫾ 3.1) and female
Global EI Across the 3 specialties, average global EI scores did not differ by gender (men n ¼ 55, 5.15 ⫾ 0.48; women n ¼ 84, 5.18 ⫾ 0.50, p ¼ 0.74).
TABLE 2. Demographic Characteristics of Study Participants by Residency Program Response rate % Gender (#) Male Female Mean age, y % Highest completed PGY (#) None PGY1 PGY2 PGY3 PGY4 PGY5
All Residents
Pathology
Pediatrics
Surgery
42.8% (139/325)
60.0% (21/35)
47.8% (33/69)
38.5% (85/221)
39.6% (55) 60.4% (84) 30.1
42.9% (9) 57.1% (12) 30.8
21.2% (7) 78.8% (26) 29.5
45.9% (39) 54.1% (46) 30.2
21.6% 19.4% 28.8% 20.1% 7.2% 2.9%
19.0% 33.3% 28.6% 4.8% 9.5% 4.8%
21.2% 30.3% 33.3% 12.1% 3.0% 0.0%
22.4% 11.8% 27.1% 27.1% 8.2% 3.5%
(30) (27) (40) (28) (10) (4)
(4) (7) (6) (1) (2) (1)
(7) (10) (11) (4) (1) (0)
(19) (10) (23) (23) (7) (3)
PGY, postgraduate year. Data are expressed as percentages (number). Journal of Surgical Education Volume 71/Number 6 November/December 2014
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TABLE 3. Emotional Intelligence of Men vs Women Resident Physicians Across Specialties All Specialties, n ¼ 139 Global EI Well-being factor Self-control factor Emotionality factor Sociability factor Happiness Optimism Self-esteem Emotion regulation Impulse control Stress management Empathy Emotion perception Emotion expression Relationships Emotion management Assertiveness Social awareness Self-motivation Adaptability
Men, n ¼ 55 Raw Score
SD
Women, n ¼ 84 Raw Score
SD
p
5.15 5.57 4.90 5.14 5.19 5.81 5.49 5.41 4.84 4.70 5.17 5.33 4.94 4.80 5.50 5.33 5.10 5.13 5.05 4.67
0.48 0.69 0.67 0.70 0.65 0.88 0.85 0.74 0.83 1.01 0.72 0.76 0.84 1.21 0.75 0.63 0.88 0.87 0.72 0.67
5.18 5.57 4.92 5.38 4.94 5.95 5.48 5.29 4.75 5.17 4.82 5.58 5.16 4.94 5.85 5.04 4.81 4.95 5.31 4.62
0.50 0.70 0.60 0.67 0.71 0.82 0.87 0.73 0.77 0.78 0.74 0.66 0.85 1.25 0.63 0.78 0.91 0.84 0.67 0.71
0.74 0.98 0.89 0.044 0.034 0.32 0.94 0.33 0.51 0.004* 0.008* 0.049 0.14 0.53 0.004* 0.023* 0.069 0.22 0.035 0.66
SD, standard deviation. Data are expressed as raw scores, which fall on a 1 to 7 scale. Women scored statistically significantly higher than men in impulse control and relationships. Men scored statistically significantly higher than women in stress management and emotion management. *p o 0.025.
EI Factors For the 3 specialties combined, men and women resident physicians were not statistically significantly different on any TEIQue factors (Table 3). The 2 factors in which men and women scored most divergently were emotionality factor, in which women residents scored higher than men (5.38 ⫾ 0.67 vs 5.14 ⫾ 0.70, p ¼ 0.044), and sociability factor, in which men scored higher than women (5.19 ⫾ 0.65 vs 4.94 ⫾ 0.71, p ¼ 0.034). EI Facets Men and women resident physicians were statistically significantly different in 4 TEIQue facets (Table 3). Women residents scored statistically significantly higher than men in impulse control (5.17 ⫾ 0.78 vs 4.70 ⫾ 1.01, p ¼ 0.004) and relationships (5.85 ⫾ 0.63 vs 5.50 ⫾ 0.75, p ¼ 0.004). Men scored significantly higher than women in stress management (5.17 ⫾ 0.72 vs 4.82 ⫾ 0.74, p ¼ 0.008), and emotion management (5.33 ⫾ 0.63 vs 5.04 ⫾ 0.78, p ¼ 0.023). EI of Surgical Residents Within the subgroup of surgery resident physicians only, men (n ¼ 39) and women (n ¼ 46) demonstrated average global EI scores of 5.19 ⫾ 0.47 and 5.23 ⫾ 0.54, respectively (p ¼ 0.76). Men and women surgical residents were statistically significantly different in 2 TEIQue facets e36
(Table 4). Women scored higher than men in impulse control (5.21 ⫾ 0.83 vs 4.62 ⫾ 1.10, p ¼ 0.006), while men scored higher in stress management (5.33 ⫾ 0.67 vs 4.88 ⫾ 0.82, p ¼ 0.008). There were no statistically significant differences between men and women surgical residents in global EI or any of the TEIQue factors.
DISCUSSION EI training has demonstrated its value within the business community, but it is still a nascent field of research in medical education despite multiple calls for its incorporation into medical training given the fundamental role of emotion in clinical medicine regarding patient care, communication, and professionalism.11,14,15,36 This study is among the first to describe and investigate the EI of men and women residents in different specialties and to examine whether discovered gender differences mirror those in the general population to better understand the role of gender when considering the design and administration of EI development interventions in graduate medical education. There was no difference in global EI between men and women in the 3 specialties in this study. Other researchers have found that women have higher overall EI than men in several studies of medical students and medical school applicants.28-32 Self-selection may have contributed to the absence of global EI differences in that only individuals with a particular overall level of EI development participated in the study. Other possibilities are that men and women in
Journal of Surgical Education Volume 71/Number 6 November/December 2014
TABLE 4. Emotional Intelligence of Men vs Women Surgical Residents Surgery Residents, n ¼ 85
Men, n ¼ 39 Raw Score
SD
Women, n ¼ 46 Raw Score
SD
p
Global EI Well-being factor Self-control factor Emotionality factor Sociability factor Happiness Optimism Self-esteem Emotion regulation Impulse control Stress management Empathy Emotion perception Emotion expression Relationships Emotion management Assertiveness Social awareness Self-motivation Adaptability
5.19 5.64 4.97 5.13 5.24 5.86 5.61 5.45 4.95 4.62 5.33 5.26 4.97 4.81 5.50 5.37 5.11 5.23 5.08 4.76
0.47 0.68 0.67 0.70 0.65 0.88 0.76 0.75 0.82 1.10 0.67 0.77 0.85 1.26 0.76 0.66 0.87 0.88 0.67 0.65
5.23 5.56 4.98 5.33 5.13 5.88 5.47 5.32 4.86 5.21 4.88 5.53 5.26 4.81 5.74 5.25 5.08 5.08 5.38 4.69
0.54 0.77 0.67 0.71 0.66 0.92 0.93 0.74 0.81 0.83 0.82 0.66 0.90 1.39 0.67 0.68 0.81 0.88 0.65 0.73
0.76 0.60 0.90 0.19 0.47 0.91 0.45 0.40 0.61 0.006* 0.008* 0.09 0.14 0.98 0.13 0.42 0.87 0.42 0.041 0.64
SD, standard deviation. Data are expressed as raw scores, which fall on a 1 to 7 scale. Women scored statistically significantly higher than men in impulse control. Men scored statistically significantly higher than women in stress management. *p o 0.025.
medical training have similar global EI scores due to selfselection into a medical career or that admissions processes for residency positions value individuals with particular overall EI levels. There were significant gender differences among resident physicians for 4 TEIQue facets. This is fewer than the number of gender differences found in a published large general population sample of more than 1800 individuals in which there are significant gender differences in 3 of 4 TEIQue factors and 11 of 15 facets.8 The areas in which men residents scored higher than women—stress management and emotion management—are areas in which men in the general population score higher than women. Similarly, just as women in the general population score higher than men in relationships, women residents in the present study scored higher than men in this facet. Contrary to the norm sample, women resident physicians also scored higher than men in impulse control. One could speculate that the specialties in this study are ones that draw women who are especially well developed in impulse control. It is also possible that this is a trait that is not valued in male applicants to these residency programs to the degree that it is in female applicants. More research is necessary to elucidate the variables that lead to a reversed gender difference among resident physicians compared with the general population. There are several potential explanations for why men and women residents score more similarly across EI domains than men and women in the general population do. The first possibility is that the study group has self-selected to medicine, i.e., medicine appeals as a career choice to a
particular subset of the general population, regardless of gender. The second is that resident or medical school selection processes select for individuals with a particular EI profile. Another explanation is that as men and women undergo the same training to become physicians, there may be effects of training on EI that erode gender differences by molding men and women toward a common type in particular facets of EI. For example, emotion expression is a TEIQue facet with significant gender differences within the general population.8 However, within this study, there was no effect of gender on emotion expression. The absence of a typical gender difference may be a result of selection, but one could conjecture that it may also be the case that women who enter medical school learn over time to suppress emotional expression to the point of eliminating this distinction with men, perhaps as a means to conform to medicine’s ethos of maintaining professional distance from patients or because they are taught that excessive emotional expression may cloud clinical reasoning. One could also speculate that men who enter medicine learn to become more emotionally expressive to communicate empathy and caring to distressed patients. Within the group of surgery resident physicians, there were fewer statistically significant gender differences than in the entire study sample and far fewer than in the published general population sample. This finding suggests that within a given specialty, men and women resident physicians are even more similar than men and women resident physicians across all specialties and much more similar than men and women at large. Again, the observation that men and women in surgery are so similar could result from self-
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selection, recruitment processes, or training effects. Our findings are consistent with those of a previously published study that demonstrated an absence of gender differences in TEIQue global or factor scores between men and women medical students interviewing for a particular general surgery residency.37 Despite the smaller number of gender differences than in the general population sample, the persistence of gender differences in certain TEIQue domains in the resident group at large and within surgery indicates that men and women resident physicians may differentially benefit from targeted EI interventions, as is the case in the general population. Program directors may want to select either areas in which both genders demonstrate lower scores or a combination of areas that address some weaknesses of men and some weaknesses of women. Within surgery, we demonstrated significant gender differences in stress management and impulse control. These are areas that surgical educators may want to differentially target in men and women surgical residents, especially given the pressure to optimize limited training time. Although each individual surgical resident has his or her own particular development needs, surgeons may want to pay special attention to impulse control in male residents and stress management in female residents, given that these are areas in which one gender is low relative to the other. The goal of any EI intervention targeted at low-development areas would be to arm residents with behavioral strategies that will enhance their ability to engage skills other than those that they are typically inclined to use. For example, training residents in negotiation strategies may provide residents who are less developed in emotion management with techniques they can employ when convincing a patient to undergo an important but uncomfortable procedure. Choosing to focus exclusively on EI domains that are already relatively strong for either men or women may not optimize the educational effect of such interventions in supporting the well-rounded development of resident physicians. Baseline trait EI assessment would aid in the selection of educational interventions aimed to ensure that the appropriate areas are addressed at both the individual and programmatic level, and investigators have now demonstrated the effectiveness of targeted EI intervention in raising the EI scores of medical students.38,39 Importantly, further work is necessary to test the assumption that changes in EI assessment scores are valid indicators of improvement in clinical performance. This study has several limitations. One limitation is the overall response rate of resident physicians of 42.8%, which falls short of the 70% response rate considered the gold standard when asserting the validity of survey results. However, the response rate in the current study is comparable to the average response rate of surveys administered to general surgery residents as determined in a recent literature review.40 It is also possible that these e38
study results suffer from self-selection bias and are therefore less generalizable to residents in all specialties and the sampled population. Other threats to generalizability are that the pathology and pediatric/med-peds residents were recruited from only a single institution and that all participants were recruited exclusively from large academic centers. The small number of respondents and the uneven gender distribution of those who did respond also limit the generalizations for these specialties. Our sample sizes of men and women also limited our ability to detect gender differences. Based on the number of participants in this study, there was 80% power to detect a gender difference on each TEIQue domain of 0.38 across all specialties and 0.48 within surgery. Increasing the sample size may result in demonstrating additional significant gender differences where none were found here. Additionally, this study did not provide adequate power to study potential interactions between specialty and gender on EI scores. Distinguishing the effect of gender vs specialty is important because the gender makeup of different specialties may be distinct. It is known that nationally more than 70% of pediatric residents are women while approximately 35% of surgery residents are women.41,42 One final study limitation regards the choice to employ the TEIQue, a trait EI tool. Employing a tool based on the trait conception of EI is appropriate for a study whose primary method involves self-assessment, because self-rating is a valid source of information regarding an individual’s personal disposition and self-perceptions in the experience of emotion. However, such a tool does not provide insight into behavior or competence. In the absence of a clinical performance variable, the relationship between TEIQue EI scores and resident physician work performance characteristics cannot be determined, though a multi-institutional study of anesthesiology residents demonstrated positive correlations between resident physician EI and acquisition of multiple ACGME core competencies.24 Future work could expand the present study’s size for greater generalizability and attain the statistical power to examine the interaction between gender and other demographic variables such as specialty or year of training. Administering an EI intervention would also enable investigation into whether EI training affects the EI scores of resident physicians or if clinical performance measures of men and women change in parallel with changes in EI scores. Ideally, measurement of resident performance would emphasize the ACGME competencies to allow further examination of the hypothesis that EI undergirds a variety of the competencies and determine if EI scores have any predictive value in clinical performance.11,24 Finally, conducting a longitudinal study may shed light on whether there are areas of trait EI in which gender differences increase or decrease across time, i.e., do men and women start out so similarly or do they become more similar during surgical residency?
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SUMMARY AND CONCLUSIONS Contrary to initial hypotheses, there was no difference between genders in global EI. Men and women resident physicians did exhibit gender differences in particular trait EI facets, suggesting that different genders may benefit from educational interventions that target different areas of EI. Interestingly, there were fewer gender differences between men and women residents than between the men and women in a published general population sample. This finding suggests that a career in medicine either selects for individuals with a particular profile or erodes gender differences as a consequence of training. Future research should explore the predictive relationship between EI and clinical performance and determine whether educational interventions aimed at the development of particular EI domains lead to enhanced resident attainment of the ACGME competencies.
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Humphrey-Murto S. Does an emotional intelligence test correlate with traditional measures used to determine medical school admission? Acad Med. 2011;86 (suppl 10):S39-S41. 31. Stratton TD, Saunders JA, Elam CL. Changes in
medical students’ emotional intelligence: an exploratory study. Teach Learn Med. 2008;20(3):279-284. 32. Carrothers RM, Gregory SW Jr., Gallagher TJ. Meas-
uring emotional intelligence of medical school applicants. Acad Med. 2000;75(5):456-463. 33. Harris
PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
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35. Mikolajczak M, Luminet O, Leroy C, Roy E. Psycho-
metric properties of the Trait Emotional Intelligence Questionnaire: factor structure, reliability, construct, and incremental validity in a French-speaking population. J Pers Assess. 2007;88(3):338-353. 36. Stoller JK, Taylor CA, Farver CF. Emotional intelli-
gence competencies provide a developmental curriculum for medical training. Med Teach. 2013;35(3): 243-247. 37. Lin DT, Kannappan A, Lau JN. The assessment of
emotional intelligence among candidates interviewing for general surgery residency. J Surg Educ. 2013;70 (4):514-521. 38. Abe K, Evans P, Austin EJ, et al. Expressing one’s
feelings and listening to others increases emotional intelligence: a pilot study of Asian medical students. BMC Med Educ. 2013;13:82. 39. Fletcher I, Leadbetter P, Curran A, O’Sullivan H. A
pilot study assessing emotional intelligence training and communication skills with 3rd year medical students. Patient Educ Couns. 2009;76(3):376-379. 40. Yarger JB, James TA, Ashikaga T, et al. Characteristics
in response rates for surveys administered to surgery residents. Surgery. 2013;154(1):38-45. 41. Frintner MP, Cull WL. Pediatric training and career
intentions, 522-528.
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42. Cochran A, Hauschild T, Elder WB, Neumayer LA,
Brasel KJ, Crandall ML. Perceived gender-based barriers to careers in academic surgery. Am J Surg. 2013; 206(2):263-268.
Journal of Surgical Education Volume 71/Number 6 November/December 2014
Are There Gender Differences in the Emotional Intelligence of Resident Physicians? Sophia K. McKinley, MD,* Emil R. Petrusa, PhD,* Carina Fiedeldey-Van Dijk, PhD,† John T. Mullen, MD,* Douglas S. Smink, MD,‡ Shannon E. Scott-Vernaglia, MD,§ Tara S. Kent, MD,|| W. Stephen Black-Schaffer, MD,¶ and Roy Phitayakorn, MD* Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; †ePsy Consultancy, Toronto, Canada; ‡Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts; § Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; ||Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and ¶Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts *
BACKGROUND: Because academic literature indicates
that emotional intelligence (EI) is tied to work performance, job satisfaction, burnout, and client satisfaction, there is great interest in understanding physician EI. OBJECTIVE: To determine whether gender differences in
resident EI profiles mirror EI gender differences in the general population. STUDY DESIGN (INCLUDE PARTICIPANTS AND SETTING): A total of 325 residents in 3 types of residency
programs (pathology, pediatrics, and general surgery) at 3 large academic institutions were invited electronically to complete the validated Trait Emotional Intelligence Questionnaire (TEIQue), a tool consisting of 153 items that cluster to 15 independent facets, 4 composite factors, and 1 global EI score. RESULTS: The response rate was 42.8% (n ¼ 139, women ¼ 84). Global EI was not significantly different between men and women resident physicians (p ¼ 0.74). Women scored higher than men in the TEIQue facets impulse control (p ¼ 0.004) and relationships (p ¼ 0.004). Men scored higher than women in 2 facets, stress management (p ¼ 0.008) and emotion management (p ¼ 0.023). Within surgery (n ¼ 85, women ¼ 46), women scored higher than men in impulse control (p ¼ 0.006), whereas men scored higher in stress management (p ¼ 0.008). CONCLUSIONS: Men and women residents across 3
specialties demonstrated near-identical global EI scores. However, gender differences in specific TEIQue facets suggest that similar to the general population, men and Correspondence: Inquiries to Sophia Kim McKinley, MD, EdM, MGH Department of Surgery, 55 Fruit St., Boston, MA 02114; e-mail: [email protected]
women residents may benefit from specific training of different EI domains to enhance well-rounded development. The lack of significant gender differences within surgery may indicate that surgery attracts individuals with particular EI profiles regardless of gender. Future research should focus on the functional relationship between educational interventions that promote targeted EI development and enhanced clinical performance. ( J Surg 71:e33-e40. C J 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: emotional intelligence, surgical education,
ACGME core competencies, surgical residency, gender differences COMPETENCIES:
Professionalism, Communication Skills, Patient Care
Interpersonal
and
INTRODUCTION Emotional intelligence (EI) describes how an individual perceives and manages his/her own emotions as well as the emotions of others. Several researchers embrace the conceptualization of EI as an ability, either as a social intelligence or a type of cognitive skill.1-5 Others have promoted a trait conceptualization of EI in which an individual’s EI reflects personal disposition.6,7 Importantly, proponents of both models assert that EI can be taught, learned, and developed.8-10 Perceiving and managing emotions is fundamental to medicine: physicians must navigate their own emotions as well as the emotions of patients and other team members. Intuitively, EI is applicable to the Accreditation Council for Graduate Medical Education (ACGME) core competencies of professionalism and of interpersonal and communication
Journal of Surgical Education & 2014 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsurg.2014.05.003
e33
skills. As such, there has been an increasing call for incorporating the development of EI into medical training.11-16 Using a variety of EI tools, different investigators have examined EI at the undergraduate and graduate medical education levels to determine whether EI has the power to predict clinical or academic performance with mixed results.17-24 What underlies these investigations is the idea that if overall EI or its subsets are tied to performance, then targeted development of those EI domains will result in enhanced outcomes. The business literature in particular has demonstrated that career success is predicted by EI and calls for EI development as a method of improving an individual’s work performance.25-27 Before designing any interventions that develop and optimize physician EI, it is important to understand if any baseline factors affect EI scores. A large general population study found a large number of gender differences in EI domains, which suggests that to achieve well-rounded development, men and women may require training in different areas.8 The present study was conducted to determine whether gender differences in resident physicians mirrored those found in the general population to ensure that future selection of EI targets inclusively benefits as many trainees as possible and does not primarily address the needs of one gender over the other. In particular, we predicted that female resident physicians would demonstrate higher global scores than male residents on an EI assessment given studies of medical students that have demonstrated this pattern.28-32
METHODS Participants and Recruitment Resident physicians in the pathology, pediatrics, medicinepediatrics (med-ped), and surgery residency programs at a large academic medical center were eligible to participate. Surgery residents at 2 other large academic centers in the same city were also invited to participate in the study. This was a convenience sample based on the agreement of the program directors of these residency programs to allow their residents to participate. Residents were invited electronically to participate in the study with up to 3 reminder invitations sent only to nonresponders. Participation in the study was voluntary. As compensation for their time, residents were offered professional, personalized EI reports valued at approximately $165. To protect participant privacy, a key linking resident identifiers to deidentified survey responses was maintained only by an administrator with no supervisory role over any residents. Study Procedures Potential study participants were invited to the study in August 2013 and allowed up to 8 weeks to complete all study materials from the date of study invitation. Each resident was provided a unique URL to complete an electronic informed consent item and a brief demographics e34
survey, which included participant age, gender, and highest completed clinical postgraduate year. Electronic consent and demographics data were collected using the REDCap electronic data capture tool hosted at Partners Healthcare.33 Research Electronic Data Capture (REDCap) is a secure, web-based application designed to support data capture for research studies. After a resident physician completed the electronic consent and demographics survey, he or she was provided with a personalized link to the main study tool, the Trait Emotional Intelligence Questionnaire (TEIQue). The EI assessment was conducted via a commercial platform (www.thomasus.com) because of its user-friendly interface and the ability to provide study participants with high-quality EI reports. No personally identifiable information was collected on the commercial website. Data collection was closed in October 2013. This study was approved by the Partners institutional review board. Trait Emotional Intelligence Questionnaire This study used the TEIQue version 1.50 (available from www.psychometriclab.com), a psychometrically validated EI questionnaire that takes approximately 15 to 25 minutes to complete. The TEIQue is a 153-item self-assessment tool for EI in which each item is answered on a 7-point Likert scale, depending on how strongly the examinee agrees or disagrees with a particular statement (1 ¼ completely disagree; 7 ¼ completely agree). These 153 items yield scores for 15 EI facets, which then cluster to 4 broader EI factors (Table 1). The 153 items in total also generate a single, global EI score. The TEIQue has been used across a variety of cultures and languages with high reliability: Cronbach α for the overall EI score ¼ 0.92 with typical Cronbach α 4 0.80 and 40.70 for TEIQue factors and facets, respectively.8,34,35 TEIQue global, factor, and facet scores for each of the participating residents were calculated on a 1 to 7 scale by Thomas International per the TEIQue scoring key held by Dr. Petrides’s group at London Psychometric Laboratory, University College London (http://www.psychometriclab.com). Statistical Analyses Subsequent analyses on TEIQue global, factor, and facet raw scores were completed using SPSS version 22 (SPSS Inc, Chicago, IL). A multivariate analysis of variance was conducted on TEIQue facet scores across gender with statistical significance set at p o 0.05. Univariate comparisons between gender groups on TEIQue global, factor, and facet scores were then conducted using the 2-tailed Student t test. For these tests, a statistically significant difference was set at p o 0.025 to reduce the inflation of type I error from multiple hypothesis testing while preserving our interest in detecting gender differences, especially given the large number of gender differences demonstrated in a published general population sample.8 Gender analyses were conducted within
Journal of Surgical Education Volume 71/Number 6 November/December 2014
TABLE 1. TEIQue Facet and Factor Descriptions Factor/Facet Well-being Happiness Optimism Self-esteem Sociability Assertiveness Emotional management Social awareness Emotionality Relationship Empathy Emotion perception Emotion expression Self-control Emotion regulation Impulse control Stress management Independent facets Adaptability Self-motivation
High Scorers Perceive Themselves as the Following Possessing a generalized sense of well-being, feeling positive, happy, and fulfilled. Cheerful and satisfied with their lives. Confident and likely to “look on the bright side” of life. Successful and self-confident. Able to communicate clearly and confidently with people from very diverse backgrounds Forthright, frank, and willing to stand up for their rights. Capable of influencing other people’s feelings. Accomplished networkers with excellent social skills. Skilled in a wide range of emotion-related activities. Capable of having fulfilling personal relationships. Capable of taking someone else’s perspective. Clear about their own and other people’s feelings. Capable of communicating their feelings to others. Having a healthy degree of control over their urges and desires. Capable of controlling their emotions. Reflective and less likely to give in to their urges. Capable of withstanding pressure and regulating stress. Flexible and willing to adapt to new conditions. Driven and unlikely to give up in the face of adversity.
The 153 items of the TEIQue generate scores for 15 distinct emotional intelligence factors, which then cluster to 4 broader emotional intelligence factors. Descriptions of each facet and factor have been adapted from the Trait Emotional Intelligence Questionnaire Technical Manual.8
the group of surgery residents because it was the largest group with a near-equal representation of men and women. Gender analyses were not conducted for pathology or pediatrics/medpeds due to small group sizes and uneven gender distributions. Of note, there were only 8 participating resident physicians who were in dual internal medicine and pediatric residency programs (med-peds) so pediatrics and med-peds residents were combined into a single specialty group.
RESULTS
participants (30.1 ⫾ 3.2) were not significantly different (p ¼ not significant). Overall, 60.4% of respondents were women, though the proportion of men vs women varied, depending on the residency program (Table 2). Multivariate Analysis A 1-way multivariate analysis of variance demonstrated a significant multivariate effect for gender (Hotelling T 2 ¼ 2,2641.58, p o 0.001).
Participants Of the 325 resident physicians who were invited to participate in the study, 139 (42.8%) completed all study materials. Age data were available for 138 (99.3%) participants. The mean age of male participants (30.2 ⫾ 3.1) and female
Global EI Across the 3 specialties, average global EI scores did not differ by gender (men n ¼ 55, 5.15 ⫾ 0.48; women n ¼ 84, 5.18 ⫾ 0.50, p ¼ 0.74).
TABLE 2. Demographic Characteristics of Study Participants by Residency Program Response rate % Gender (#) Male Female Mean age, y % Highest completed PGY (#) None PGY1 PGY2 PGY3 PGY4 PGY5
All Residents
Pathology
Pediatrics
Surgery
42.8% (139/325)
60.0% (21/35)
47.8% (33/69)
38.5% (85/221)
39.6% (55) 60.4% (84) 30.1
42.9% (9) 57.1% (12) 30.8
21.2% (7) 78.8% (26) 29.5
45.9% (39) 54.1% (46) 30.2
21.6% 19.4% 28.8% 20.1% 7.2% 2.9%
19.0% 33.3% 28.6% 4.8% 9.5% 4.8%
21.2% 30.3% 33.3% 12.1% 3.0% 0.0%
22.4% 11.8% 27.1% 27.1% 8.2% 3.5%
(30) (27) (40) (28) (10) (4)
(4) (7) (6) (1) (2) (1)
(7) (10) (11) (4) (1) (0)
(19) (10) (23) (23) (7) (3)
PGY, postgraduate year. Data are expressed as percentages (number). Journal of Surgical Education Volume 71/Number 6 November/December 2014
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TABLE 3. Emotional Intelligence of Men vs Women Resident Physicians Across Specialties All Specialties, n ¼ 139 Global EI Well-being factor Self-control factor Emotionality factor Sociability factor Happiness Optimism Self-esteem Emotion regulation Impulse control Stress management Empathy Emotion perception Emotion expression Relationships Emotion management Assertiveness Social awareness Self-motivation Adaptability
Men, n ¼ 55 Raw Score
SD
Women, n ¼ 84 Raw Score
SD
p
5.15 5.57 4.90 5.14 5.19 5.81 5.49 5.41 4.84 4.70 5.17 5.33 4.94 4.80 5.50 5.33 5.10 5.13 5.05 4.67
0.48 0.69 0.67 0.70 0.65 0.88 0.85 0.74 0.83 1.01 0.72 0.76 0.84 1.21 0.75 0.63 0.88 0.87 0.72 0.67
5.18 5.57 4.92 5.38 4.94 5.95 5.48 5.29 4.75 5.17 4.82 5.58 5.16 4.94 5.85 5.04 4.81 4.95 5.31 4.62
0.50 0.70 0.60 0.67 0.71 0.82 0.87 0.73 0.77 0.78 0.74 0.66 0.85 1.25 0.63 0.78 0.91 0.84 0.67 0.71
0.74 0.98 0.89 0.044 0.034 0.32 0.94 0.33 0.51 0.004* 0.008* 0.049 0.14 0.53 0.004* 0.023* 0.069 0.22 0.035 0.66
SD, standard deviation. Data are expressed as raw scores, which fall on a 1 to 7 scale. Women scored statistically significantly higher than men in impulse control and relationships. Men scored statistically significantly higher than women in stress management and emotion management. *p o 0.025.
EI Factors For the 3 specialties combined, men and women resident physicians were not statistically significantly different on any TEIQue factors (Table 3). The 2 factors in which men and women scored most divergently were emotionality factor, in which women residents scored higher than men (5.38 ⫾ 0.67 vs 5.14 ⫾ 0.70, p ¼ 0.044), and sociability factor, in which men scored higher than women (5.19 ⫾ 0.65 vs 4.94 ⫾ 0.71, p ¼ 0.034). EI Facets Men and women resident physicians were statistically significantly different in 4 TEIQue facets (Table 3). Women residents scored statistically significantly higher than men in impulse control (5.17 ⫾ 0.78 vs 4.70 ⫾ 1.01, p ¼ 0.004) and relationships (5.85 ⫾ 0.63 vs 5.50 ⫾ 0.75, p ¼ 0.004). Men scored significantly higher than women in stress management (5.17 ⫾ 0.72 vs 4.82 ⫾ 0.74, p ¼ 0.008), and emotion management (5.33 ⫾ 0.63 vs 5.04 ⫾ 0.78, p ¼ 0.023). EI of Surgical Residents Within the subgroup of surgery resident physicians only, men (n ¼ 39) and women (n ¼ 46) demonstrated average global EI scores of 5.19 ⫾ 0.47 and 5.23 ⫾ 0.54, respectively (p ¼ 0.76). Men and women surgical residents were statistically significantly different in 2 TEIQue facets e36
(Table 4). Women scored higher than men in impulse control (5.21 ⫾ 0.83 vs 4.62 ⫾ 1.10, p ¼ 0.006), while men scored higher in stress management (5.33 ⫾ 0.67 vs 4.88 ⫾ 0.82, p ¼ 0.008). There were no statistically significant differences between men and women surgical residents in global EI or any of the TEIQue factors.
DISCUSSION EI training has demonstrated its value within the business community, but it is still a nascent field of research in medical education despite multiple calls for its incorporation into medical training given the fundamental role of emotion in clinical medicine regarding patient care, communication, and professionalism.11,14,15,36 This study is among the first to describe and investigate the EI of men and women residents in different specialties and to examine whether discovered gender differences mirror those in the general population to better understand the role of gender when considering the design and administration of EI development interventions in graduate medical education. There was no difference in global EI between men and women in the 3 specialties in this study. Other researchers have found that women have higher overall EI than men in several studies of medical students and medical school applicants.28-32 Self-selection may have contributed to the absence of global EI differences in that only individuals with a particular overall level of EI development participated in the study. Other possibilities are that men and women in
Journal of Surgical Education Volume 71/Number 6 November/December 2014
TABLE 4. Emotional Intelligence of Men vs Women Surgical Residents Surgery Residents, n ¼ 85
Men, n ¼ 39 Raw Score
SD
Women, n ¼ 46 Raw Score
SD
p
Global EI Well-being factor Self-control factor Emotionality factor Sociability factor Happiness Optimism Self-esteem Emotion regulation Impulse control Stress management Empathy Emotion perception Emotion expression Relationships Emotion management Assertiveness Social awareness Self-motivation Adaptability
5.19 5.64 4.97 5.13 5.24 5.86 5.61 5.45 4.95 4.62 5.33 5.26 4.97 4.81 5.50 5.37 5.11 5.23 5.08 4.76
0.47 0.68 0.67 0.70 0.65 0.88 0.76 0.75 0.82 1.10 0.67 0.77 0.85 1.26 0.76 0.66 0.87 0.88 0.67 0.65
5.23 5.56 4.98 5.33 5.13 5.88 5.47 5.32 4.86 5.21 4.88 5.53 5.26 4.81 5.74 5.25 5.08 5.08 5.38 4.69
0.54 0.77 0.67 0.71 0.66 0.92 0.93 0.74 0.81 0.83 0.82 0.66 0.90 1.39 0.67 0.68 0.81 0.88 0.65 0.73
0.76 0.60 0.90 0.19 0.47 0.91 0.45 0.40 0.61 0.006* 0.008* 0.09 0.14 0.98 0.13 0.42 0.87 0.42 0.041 0.64
SD, standard deviation. Data are expressed as raw scores, which fall on a 1 to 7 scale. Women scored statistically significantly higher than men in impulse control. Men scored statistically significantly higher than women in stress management. *p o 0.025.
medical training have similar global EI scores due to selfselection into a medical career or that admissions processes for residency positions value individuals with particular overall EI levels. There were significant gender differences among resident physicians for 4 TEIQue facets. This is fewer than the number of gender differences found in a published large general population sample of more than 1800 individuals in which there are significant gender differences in 3 of 4 TEIQue factors and 11 of 15 facets.8 The areas in which men residents scored higher than women—stress management and emotion management—are areas in which men in the general population score higher than women. Similarly, just as women in the general population score higher than men in relationships, women residents in the present study scored higher than men in this facet. Contrary to the norm sample, women resident physicians also scored higher than men in impulse control. One could speculate that the specialties in this study are ones that draw women who are especially well developed in impulse control. It is also possible that this is a trait that is not valued in male applicants to these residency programs to the degree that it is in female applicants. More research is necessary to elucidate the variables that lead to a reversed gender difference among resident physicians compared with the general population. There are several potential explanations for why men and women residents score more similarly across EI domains than men and women in the general population do. The first possibility is that the study group has self-selected to medicine, i.e., medicine appeals as a career choice to a
particular subset of the general population, regardless of gender. The second is that resident or medical school selection processes select for individuals with a particular EI profile. Another explanation is that as men and women undergo the same training to become physicians, there may be effects of training on EI that erode gender differences by molding men and women toward a common type in particular facets of EI. For example, emotion expression is a TEIQue facet with significant gender differences within the general population.8 However, within this study, there was no effect of gender on emotion expression. The absence of a typical gender difference may be a result of selection, but one could conjecture that it may also be the case that women who enter medical school learn over time to suppress emotional expression to the point of eliminating this distinction with men, perhaps as a means to conform to medicine’s ethos of maintaining professional distance from patients or because they are taught that excessive emotional expression may cloud clinical reasoning. One could also speculate that men who enter medicine learn to become more emotionally expressive to communicate empathy and caring to distressed patients. Within the group of surgery resident physicians, there were fewer statistically significant gender differences than in the entire study sample and far fewer than in the published general population sample. This finding suggests that within a given specialty, men and women resident physicians are even more similar than men and women resident physicians across all specialties and much more similar than men and women at large. Again, the observation that men and women in surgery are so similar could result from self-
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selection, recruitment processes, or training effects. Our findings are consistent with those of a previously published study that demonstrated an absence of gender differences in TEIQue global or factor scores between men and women medical students interviewing for a particular general surgery residency.37 Despite the smaller number of gender differences than in the general population sample, the persistence of gender differences in certain TEIQue domains in the resident group at large and within surgery indicates that men and women resident physicians may differentially benefit from targeted EI interventions, as is the case in the general population. Program directors may want to select either areas in which both genders demonstrate lower scores or a combination of areas that address some weaknesses of men and some weaknesses of women. Within surgery, we demonstrated significant gender differences in stress management and impulse control. These are areas that surgical educators may want to differentially target in men and women surgical residents, especially given the pressure to optimize limited training time. Although each individual surgical resident has his or her own particular development needs, surgeons may want to pay special attention to impulse control in male residents and stress management in female residents, given that these are areas in which one gender is low relative to the other. The goal of any EI intervention targeted at low-development areas would be to arm residents with behavioral strategies that will enhance their ability to engage skills other than those that they are typically inclined to use. For example, training residents in negotiation strategies may provide residents who are less developed in emotion management with techniques they can employ when convincing a patient to undergo an important but uncomfortable procedure. Choosing to focus exclusively on EI domains that are already relatively strong for either men or women may not optimize the educational effect of such interventions in supporting the well-rounded development of resident physicians. Baseline trait EI assessment would aid in the selection of educational interventions aimed to ensure that the appropriate areas are addressed at both the individual and programmatic level, and investigators have now demonstrated the effectiveness of targeted EI intervention in raising the EI scores of medical students.38,39 Importantly, further work is necessary to test the assumption that changes in EI assessment scores are valid indicators of improvement in clinical performance. This study has several limitations. One limitation is the overall response rate of resident physicians of 42.8%, which falls short of the 70% response rate considered the gold standard when asserting the validity of survey results. However, the response rate in the current study is comparable to the average response rate of surveys administered to general surgery residents as determined in a recent literature review.40 It is also possible that these e38
study results suffer from self-selection bias and are therefore less generalizable to residents in all specialties and the sampled population. Other threats to generalizability are that the pathology and pediatric/med-peds residents were recruited from only a single institution and that all participants were recruited exclusively from large academic centers. The small number of respondents and the uneven gender distribution of those who did respond also limit the generalizations for these specialties. Our sample sizes of men and women also limited our ability to detect gender differences. Based on the number of participants in this study, there was 80% power to detect a gender difference on each TEIQue domain of 0.38 across all specialties and 0.48 within surgery. Increasing the sample size may result in demonstrating additional significant gender differences where none were found here. Additionally, this study did not provide adequate power to study potential interactions between specialty and gender on EI scores. Distinguishing the effect of gender vs specialty is important because the gender makeup of different specialties may be distinct. It is known that nationally more than 70% of pediatric residents are women while approximately 35% of surgery residents are women.41,42 One final study limitation regards the choice to employ the TEIQue, a trait EI tool. Employing a tool based on the trait conception of EI is appropriate for a study whose primary method involves self-assessment, because self-rating is a valid source of information regarding an individual’s personal disposition and self-perceptions in the experience of emotion. However, such a tool does not provide insight into behavior or competence. In the absence of a clinical performance variable, the relationship between TEIQue EI scores and resident physician work performance characteristics cannot be determined, though a multi-institutional study of anesthesiology residents demonstrated positive correlations between resident physician EI and acquisition of multiple ACGME core competencies.24 Future work could expand the present study’s size for greater generalizability and attain the statistical power to examine the interaction between gender and other demographic variables such as specialty or year of training. Administering an EI intervention would also enable investigation into whether EI training affects the EI scores of resident physicians or if clinical performance measures of men and women change in parallel with changes in EI scores. Ideally, measurement of resident performance would emphasize the ACGME competencies to allow further examination of the hypothesis that EI undergirds a variety of the competencies and determine if EI scores have any predictive value in clinical performance.11,24 Finally, conducting a longitudinal study may shed light on whether there are areas of trait EI in which gender differences increase or decrease across time, i.e., do men and women start out so similarly or do they become more similar during surgical residency?
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SUMMARY AND CONCLUSIONS Contrary to initial hypotheses, there was no difference between genders in global EI. Men and women resident physicians did exhibit gender differences in particular trait EI facets, suggesting that different genders may benefit from educational interventions that target different areas of EI. Interestingly, there were fewer gender differences between men and women residents than between the men and women in a published general population sample. This finding suggests that a career in medicine either selects for individuals with a particular profile or erodes gender differences as a consequence of training. Future research should explore the predictive relationship between EI and clinical performance and determine whether educational interventions aimed at the development of particular EI domains lead to enhanced resident attainment of the ACGME competencies.
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Sevdalis N. Emotional intelligence in medicine: a systematic review through the context of the ACGME competencies. Med Educ. 2010;44(8):749-764. 12. Grewal D, Davidson HA. Emotional intelligence and
graduate medical education. J Am Med Assoc, 300; 2008. 1200-1202. 13. Lewis NJ, Rees CE, Hudson JN, Bleakley A. Emo-
tional intelligence medical education: measuring the unmeasurable? Adv Health Sci Educ Theory Pract. 2005;10(4):339-355. 14. Pilkington A, Hart J, Bundy C. Training obstetricians
and gynaecologists to be emotionally intelligent. J Obstet Gynaecol. 2012;32(1):10-13. 15. Taylor C, Farver C, Stoller JK. Perspective: Can
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